胃癌および食道癌手術の周術期管理に関する診療報酬算定の状況に関する施設アンケート調査とNational Clinical Databaseを紐づけたアウトカム解析
目的：術後早期回復プログラムの普及にともない，周術期管理に関する診療報酬算定が可能となったが，算定による合併症抑制効果を臨床データと紐づけて解析した大規模な報告は少ない．今回，上部消化管手術を対象とした．周術期管理に関連する診療報酬加算の算定状況をアンケート調査し，National Clinical Database（以下，NCDと略記）と紐付けたうえで合併症抑制効果を解析することを目的とした．方法：日本消化器外科学会認定施設のうち上部消化管手術を実施している診療科を対象にアンケートを行い，周術期管理に関連する診療報酬8項目の算定の有無を調査した．NCDの術後アウトカム（術後合併症発症率，術後...
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| Published in | 日本消化器外科学会雑誌 Vol. 57; no. 2; pp. 51 - 59 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
01.02.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.2023.0009 |
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| Abstract | 目的：術後早期回復プログラムの普及にともない，周術期管理に関する診療報酬算定が可能となったが，算定による合併症抑制効果を臨床データと紐づけて解析した大規模な報告は少ない．今回，上部消化管手術を対象とした．周術期管理に関連する診療報酬加算の算定状況をアンケート調査し，National Clinical Database（以下，NCDと略記）と紐付けたうえで合併症抑制効果を解析することを目的とした．方法：日本消化器外科学会認定施設のうち上部消化管手術を実施している診療科を対象にアンケートを行い，周術期管理に関連する診療報酬8項目の算定の有無を調査した．NCDの術後アウトカム（術後合併症発症率，術後30日以内の死亡率，術後在院日数）と紐づけし統計学的解析を行った．結果：認定施設884施設のうち633施設（71.6%）から回答を得た．栄養サポートチーム加算＋歯科医師連携加算は算定ありが，幽門側胃切除術および胃全摘術で有意に短い術後在院日数を示し，食道切除再建術では術後30日以内の死亡率が有意に低かった．周術期口腔機能管理後手術加算は算定ありが，いずれの術式でも術後在院日数が有意に短く，食道切除再建術では術後30日以内の死亡率が有意に低かった．結語：胃癌手術，食道癌手術において，診療報酬の算定状況と術後合併症の相関が明らかとなった． |
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| AbstractList | 目的：術後早期回復プログラムの普及にともない，周術期管理に関する診療報酬算定が可能となったが，算定による合併症抑制効果を臨床データと紐づけて解析した大規模な報告は少ない．今回，上部消化管手術を対象とした．周術期管理に関連する診療報酬加算の算定状況をアンケート調査し，National Clinical Database（以下，NCDと略記）と紐付けたうえで合併症抑制効果を解析することを目的とした．方法：日本消化器外科学会認定施設のうち上部消化管手術を実施している診療科を対象にアンケートを行い，周術期管理に関連する診療報酬8項目の算定の有無を調査した．NCDの術後アウトカム（術後合併症発症率，術後30日以内の死亡率，術後在院日数）と紐づけし統計学的解析を行った．結果：認定施設884施設のうち633施設（71.6%）から回答を得た．栄養サポートチーム加算＋歯科医師連携加算は算定ありが，幽門側胃切除術および胃全摘術で有意に短い術後在院日数を示し，食道切除再建術では術後30日以内の死亡率が有意に低かった．周術期口腔機能管理後手術加算は算定ありが，いずれの術式でも術後在院日数が有意に短く，食道切除再建術では術後30日以内の死亡率が有意に低かった．結語：胃癌手術，食道癌手術において，診療報酬の算定状況と術後合併症の相関が明らかとなった． |
| Author | 金治, 新悟 絹川, 直子 愛甲, 丞 北川, 雄光 瀬戸, 泰之 山下, 裕玄 掛地, 吉弘 隈丸, 拓 |
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| References | 20) Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–650. 4) Fujikuni N, Tanabe K, Tokumoto N, Suzuki T, Hattori M, Misumi T, et al. Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy. World J Gastrointest Surg. 2016;8(5):382–388. 31) Wang X, Yao Y, Qian H, Li H, Zhu X. Longer operating time during gastrectomy has adverse effects on short-term surgical outcomes. J Surg Res. 2019;243:151–159. 32) 小柳 由恵，秋山 結美子，野崎 祥子，山上 淳，岡部 圭介，貴志 和生．当院の褥瘡ハイリスク患者ケア加算算定患者における褥瘡発生の現状と課題．日本褥瘡学会誌．2019;21(1):41–44. 13) 掛地, 吉弘，長谷川 寛，金治, 新悟．National Clinical Databaseから何が引き出せるか．外科．2020;82(8):830–835. 9) Marubashi S, Ichihara N, Kakeji Y, Miyata H, Taketomi A, Egawa H, et al. ”Real-time” risk models of postoperative morbidity and mortality for liver transplants. Ann Gastroenterol Surg. 2018;3(1):75–95. 26) 船原 まどか．がん手術時の口腔管理方法の標準化を目指して．九州歯科学会雑誌．2019;73(2):33–38. 5) Ohkura Y, Shindoh J, Ueno M, Iizuka T, Haruta S, Udagawa H. A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis. Surg Today. 2018;48(5):502–509. 22) Mistiaen P, Van den Heede K. Nutrition support teams: a systematic review. JPEN J Parenter Enteral Nutr. 2020;44(6):1004–1020. 27) Watanabe M, Okamura A, Toihata T, Yamashita K, Yuda M, Hayami M, et al. Recent progress in perioperative management of patients undergoing esophagectomy for esophageal cancer. Esophagus. 2018;15(3):160–164. 6) Konno H, Kamiya K, Kikuchi H, Miyata H, Hirahara N, Gotoh M, et al. Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures. Surg Today. 2017;47(5):611–618. 34) 保険医療2035策定懇談会．保険医療2035提言書［Internet］．東京：厚生労働省．［cited 2020 Dec 17］．Available from: https://www.mhlw.go.jp/stf/shingi2/0000088369.html. 8) Mizushima T, Yamamoto H, Marubashi S, Kamiya K, Wakabayashi G, Miyata H, et al. Validity and significance of 30-day mortality rate as a quality indicator for gastrointestinal cancer surgeries. Ann Gastroenterol Surg. 2018;2(3):231–240. 17) Zhou J, Hiki N, Mine S, Kumagai K, Ida S, Jiang X, et al. Role of prealbumin as a powerful and simple index for predicting postoperative complications after gastric cancer surgery. Ann Surg Oncol. 2017;24(2):510–517. 23) 五月女 さき子，船原 まどか，於保 孝彦，山田 慎一，栗田 浩，山内 千佳，ほか．食道がん術後肺炎予防に対する周術期口腔機能管理の有効性 多施設共同後ろ向き研究による検証．日本口腔科学会雑誌．2016;65(4):324–329. 12) 後藤 満一，宮田 裕章，杉原 健一，岩中 督，里見 進．NCDの将来展望．臨床外科．2012;67(6):752–755. 21) Cheng Y, Zhang J, Zhang L, Wu J, Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018;18(1):11. 29) Doganay E, Moorthy K. Prehabilitation for esophagectomy. J Thorac Dis. 2019;11(suppl 5):S632–S638. 10) Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260(6):1034–1039. 14) 塚本 忠司．腹腔鏡下肝・膵切除術の保険収載への道のり．日本外科系連合学会誌．2016;41(4):724–728. 30) Valsangkar N, Salfity HVN, Timsina L, Ceppa DP, Ceppa EP, Birdas TJ. Operative time in esophagectomy: Does it affect outcomes? Surgery. 2018;164(4):866–871. 16) Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Eguchi S, Endo I, et al. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011–2018. Ann Gastroenterol Surg. 2020;4(3):250–274. 25) 康永 秀生．歯科医によるがん手術前口腔ケアと術後肺炎発症率および死亡率の関連：NDBデータを用いた分析．歯界月報．2019;811:36–38. 3) Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014;259(3):413–431. 2) Beamish AJ, Chan DS, Blake PA, Karran A, Lewis WG. Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery. Int J Surg. 2015;19:46–54. 28) Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, et al. Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2019;43(2):299–330. 33) Chou CL, Lee WR, Yeh CC, Shih CC, Chen TL, Liao CC. Adverse outcomes after major surgery in patients with pressure ulcer: a nationwide population-based retrospective cohort study. PLoS One. 2015;10(5):e0127731. 18) Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K. Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol. 2002;28(4):396–400. 24) Soutome S, Yanamoto S, Funahara M, Hasegawa T, Komori T, Yamada S, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: a multicenter case-control study with propensity score matching analysis. Medicine (Baltimore). 2017;96:e7436. 19) Kubota K, Kuroda J, Yoshida M, Okada A, Deguchi T, Kitajima M. Preoperative oral supplementation support in patients with esophageal cancer. J Nutr Health Aging. 2014;18(4):437–440. 7) Anazawa T, Paruch JL, Miyata H, Gotoh M, Ko CY, Cohen ME, et al. Comparison of national operative mortality in gastroenterological surgery using web-based prospective data entry systems. Medicine (Baltimore). 2015;94(49):e2194. 1) Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg. 2014;101:1209–1229. 11) Marubashi S, Liu JY, Miyata H, Cohen ME, Ko CY, Seto Y, et al. Surgical quality improvement programs in Japan and USA: Report from the collaborative projects between Japanese Society of Gastroenterological Surgery and American College of Surgeons National Surgical Quality Improvement Program. Ann Gastroenterol Surg. 2019;3(4):343–351. 15) Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, et al. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer. 2019;22:202–213. |
| References_xml | – reference: 12) 後藤 満一，宮田 裕章，杉原 健一，岩中 督，里見 進．NCDの将来展望．臨床外科．2012;67(6):752–755. – reference: 13) 掛地, 吉弘，長谷川 寛，金治, 新悟．National Clinical Databaseから何が引き出せるか．外科．2020;82(8):830–835. – reference: 14) 塚本 忠司．腹腔鏡下肝・膵切除術の保険収載への道のり．日本外科系連合学会誌．2016;41(4):724–728. – reference: 11) Marubashi S, Liu JY, Miyata H, Cohen ME, Ko CY, Seto Y, et al. Surgical quality improvement programs in Japan and USA: Report from the collaborative projects between Japanese Society of Gastroenterological Surgery and American College of Surgeons National Surgical Quality Improvement Program. Ann Gastroenterol Surg. 2019;3(4):343–351. – reference: 30) Valsangkar N, Salfity HVN, Timsina L, Ceppa DP, Ceppa EP, Birdas TJ. Operative time in esophagectomy: Does it affect outcomes? Surgery. 2018;164(4):866–871. – reference: 25) 康永 秀生．歯科医によるがん手術前口腔ケアと術後肺炎発症率および死亡率の関連：NDBデータを用いた分析．歯界月報．2019;811:36–38. – reference: 2) Beamish AJ, Chan DS, Blake PA, Karran A, Lewis WG. Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery. Int J Surg. 2015;19:46–54. – reference: 20) Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–650. – reference: 21) Cheng Y, Zhang J, Zhang L, Wu J, Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018;18(1):11. – reference: 23) 五月女 さき子，船原 まどか，於保 孝彦，山田 慎一，栗田 浩，山内 千佳，ほか．食道がん術後肺炎予防に対する周術期口腔機能管理の有効性 多施設共同後ろ向き研究による検証．日本口腔科学会雑誌．2016;65(4):324–329. – reference: 26) 船原 まどか．がん手術時の口腔管理方法の標準化を目指して．九州歯科学会雑誌．2019;73(2):33–38. – reference: 33) Chou CL, Lee WR, Yeh CC, Shih CC, Chen TL, Liao CC. Adverse outcomes after major surgery in patients with pressure ulcer: a nationwide population-based retrospective cohort study. PLoS One. 2015;10(5):e0127731. – reference: 8) Mizushima T, Yamamoto H, Marubashi S, Kamiya K, Wakabayashi G, Miyata H, et al. Validity and significance of 30-day mortality rate as a quality indicator for gastrointestinal cancer surgeries. Ann Gastroenterol Surg. 2018;2(3):231–240. – reference: 15) Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, et al. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer. 2019;22:202–213. – reference: 9) Marubashi S, Ichihara N, Kakeji Y, Miyata H, Taketomi A, Egawa H, et al. ”Real-time” risk models of postoperative morbidity and mortality for liver transplants. Ann Gastroenterol Surg. 2018;3(1):75–95. – reference: 27) Watanabe M, Okamura A, Toihata T, Yamashita K, Yuda M, Hayami M, et al. Recent progress in perioperative management of patients undergoing esophagectomy for esophageal cancer. Esophagus. 2018;15(3):160–164. – reference: 6) Konno H, Kamiya K, Kikuchi H, Miyata H, Hirahara N, Gotoh M, et al. Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures. Surg Today. 2017;47(5):611–618. – reference: 10) Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260(6):1034–1039. – reference: 3) Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014;259(3):413–431. – reference: 29) Doganay E, Moorthy K. Prehabilitation for esophagectomy. J Thorac Dis. 2019;11(suppl 5):S632–S638. – reference: 16) Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Eguchi S, Endo I, et al. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011–2018. Ann Gastroenterol Surg. 2020;4(3):250–274. – reference: 32) 小柳 由恵，秋山 結美子，野崎 祥子，山上 淳，岡部 圭介，貴志 和生．当院の褥瘡ハイリスク患者ケア加算算定患者における褥瘡発生の現状と課題．日本褥瘡学会誌．2019;21(1):41–44. – reference: 17) Zhou J, Hiki N, Mine S, Kumagai K, Ida S, Jiang X, et al. Role of prealbumin as a powerful and simple index for predicting postoperative complications after gastric cancer surgery. Ann Surg Oncol. 2017;24(2):510–517. – reference: 18) Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K. Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol. 2002;28(4):396–400. – reference: 28) Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, et al. Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2019;43(2):299–330. – reference: 34) 保険医療2035策定懇談会．保険医療2035提言書［Internet］．東京：厚生労働省．［cited 2020 Dec 17］．Available from: https://www.mhlw.go.jp/stf/shingi2/0000088369.html. – reference: 5) Ohkura Y, Shindoh J, Ueno M, Iizuka T, Haruta S, Udagawa H. A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis. Surg Today. 2018;48(5):502–509. – reference: 24) Soutome S, Yanamoto S, Funahara M, Hasegawa T, Komori T, Yamada S, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: a multicenter case-control study with propensity score matching analysis. Medicine (Baltimore). 2017;96:e7436. – reference: 1) Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. 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| Snippet | 目的：術後早期回復プログラムの普及にともない，周術期管理に関する診療報酬算定が可能となったが，算定による合併症抑制効果を臨床データと紐づけて解析した大規模な報告は少ない．今回，上部消化管手術を対象とした．周術期管理に関連する診療報酬加算の算定状況をアンケート調査し，National Clinical... |
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| StartPage | 51 |
| SubjectTerms | ERAS National Clinical Database 上部消化管手術 診療報酬 |
| Title | 胃癌および食道癌手術の周術期管理に関する診療報酬算定の状況に関する施設アンケート調査とNational Clinical Databaseを紐づけたアウトカム解析 |
| URI | https://www.jstage.jst.go.jp/article/jjgs/57/2/57_2023.0009/_article/-char/ja |
| Volume | 57 |
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| ispartofPNX | 日本消化器外科学会雑誌, 2024/02/01, Vol.57(2), pp.51-59 |
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